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As a new nurse, I remember how frightened I was that someone would die do my lack of experience or a poor judgment call. I will never forget my one instructor who said, “You will make a medication error at some point in your nursing career.” That statement shook me to the core. How could that happen? During my orientation on the medical/surgical step down unit, I witnessed nurses nonchalantly switching out I.V. bags of different solutions without first checking the drugs compatibility. What if one of those medications causes a precipitate to form in the line? Then what? Someone could die of an embolism!
Soon I was on my own shift with my own patient load. The fears that plagued me during nursing school did not magically disappear, but instead became magnified. I was a nervous wreck. How did these other nurses manage their patient load with such grace under pressure? When would this ominous fear of doing something wrong let up? For me, it never did. The delicate balance between life and death based on a decision or action is what kept me sharp. Eventually I was able to display a calm exterior while internally; I was ready to react at the slightest change in my patient’s condition. There were no cutting corners. I know that sounds crazy. Obviously, when there were no washcloths we had to use towels, or sometimes we had to make do with what supplies were on the floor. Did I ever deliberately cut a corner just to save time? The answer is no. Everything that I do is for my patient. Even the smallest action of making a toe pleat in the bed or mitering a corner was a action of respect for the patient in that bed.
Nursing school prepared me with critical thinking skills. As my experience as nurse progressed, I became better at assessing a patient’s condition. I would not say that I became an expert according to Benner’s Stages of Critical Competence.(Benner, 2011, para. 5)
Making a competent clinical decision is not based on just one lab result or a patient’s symptoms. The personality traits of going above and beyond, taking risks and deliberate practice seem to be the traits that make an expert nurse.(Kaminski, 2010, p. 967)
Benner’s Stages(Benner, 2011, table 1) verified that I have much to learn. I am looking forward to learning more about evidenced based practice and the critical thinking skills necessary in advanced practice nursing.
Advanced Practice Nurses have the responsibility of providing and documenting research on evidenced based practice for the nursing profession as a whole. Nursing continues to develop and progress into a clinical science. This development is due to the efforts of those nurses who understand the dynamics of change in the role of the nurse in today’s society.

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